2018 World IFA Congress Presentation at Hiroshima: Text of PPt (1 of 2)

 •       Rational Emotive Behavior Therapy of Stuttering: Theory and Teletherapy Techniques

•       Gunars K. Neiders, Psy.D., Ph.D.

•       Heather Grossman, Ph.D.

•       Disclosure

The presenter, Gunars Neiders, Ph.D, Psy.D, DOES NOT have an interest in selling a technology, program, product, and/or service to Speech and Language Professionals besides, maybe, increasing his book sales. The non-presenting author, Heather Grossman, Ph.D., is the director of non-profit American Institute for Stuttering.

•       About the handout, presentation, and copyright

•       The handout tells the whole story of internet based Rational Emotive  Behavior Therapy of Stuttering (REBTS).

•       There is not enough time to go over all the slides. I will be pitching some of the slides; others will be marked as “Background information”

•       All copyrighted charts may be used with acknowledgement.

•       Sheehan’s Stuttering Iceberg

•       How Does REBTS differ from traditional stuttering modification and fluency shaping?

•       Fluency shaping and to a greater or lesser degree, traditional stuttering modification focuses on the speech formation aspect.

•       REBTS focuses on adjusting the self-talk system, especially the emotional state, and uses immersion in easy bounces as the only speech formation tool.

•       REBT can  be used with fluency shaping and stuttering modification to improve self-talk, unconditional self-and stuttering acceptance, and in motivation to carry out desensitization, disclosure, and transference assignments to improve the outcomes.

•       REBTS view of how we react to speaking situations to have forced/struggling stuttering or free/flowing speech:

•       Common irrational self-talk includes:

  1. I must talk perfectly fluently.
  2. It would be awful if I stuttered.
  3. I can’t stand stuttering.
  4. If I stutter I am worthless.
  5. I should be damned for stuttering. 

•       Or

•       I have to, absolutely have to, be able to communicate.

•       If I can’t communicate I would lose my job and it would be awful.

•       But often this is all so unlikely and probably would never happen.

•       Amygdala senses threat:

•       The amygdala, classically conditioned, generates fight, flight, or freeze command.

•       The brain stem releases hormones, e.g., causes heart to race, sweat, etc.

•       The Pre Frontal Cortex includes speech generating Broca area which is disturbed to cause forced/struggled stuttering.

•       REBTS model why we stutter (the immediate reaction):

•       The main function of amygdala is emotional and social processing. It processes and stores memories of emotional events and is also involved in current emotional responses.

•       As applied to stuttering:

–      A stressful speech situation

–      activates the memories of past traumatic experiences with speech,

–      triggers fight, flight or freeze reaction,

–      and results in initiating forced/struggling stuttering.

•       REBTS model why we stutter (after processing in PFC):

•       “Men are disturbed not by things, but by the view which they take of them.” Epictetus

•       As applied to stuttering:

–      Stressful speech situation evokes unhelpful self-talk and attitudes,

–      triggers disturbed feelings of anxiety, shame, etc..

–      and messes with fine motor control of speech mechanisms resulting in forced/struggling stuttering.

Reminder much of the processing occurs in PFC in Broca Area, that generates the fine control speech motor signals

•       To achieve recovery REBTS:

•       works on changing self-talk and emotions that contribute to stuttering,

•       includes exercises to desensitize amygdala to become less prone to judging a speech situation as dangerous,

•       uses REBT to keep a client motivated and builds courage to perform desensitization exercises, and

•       uses immersion in easy bounces to build a habit of neurons firing together to override the forcing and struggling.

•       Paraphrasing, the four threads of REBTS are:

•       Motivation to do the work necessary for recovery

•       Anxiety, shame, guilt, helplessness and other unhealthy negative emotion reduction

•       Unconditional self-acceptance and acknowledgement of stuttering

•       Immersion in easy bounces to acknowledge stuttering and reduce the forcing and struggling in stuttering

Client is asked each session to report progress using the acronym: MAUI

•       Easy bounces: (1 of 2)

•       are easy repetitions that are similar to the utterings of a child as he learns to talk: i.e. ma-ma da-da-da;

•       immersion consists of constantly talking to oneself and using easy bounces when alone, conversing with other people and inserting one or two easy bounces, or, when in foot traffic, acting as if one is talking on the smart phone;

•       are introduced by the therapist in first or second session when a client is asked to repeat after the therapist a-apple, be-be-bear, ca-ca-cat etc.;

•       Easy bounces: (2 of 2)

•       serve as voluntary stuttering, especially on words the PWS does not stutter;

•       are used to introduce sound in a silent block;

•       are used to keep a stutter going until there is a feeling of control and only then proceed to say the rest of the word;

•       are used to pre-empt a stutter, i.e. as a substitute for an oncoming stutter on a word.

•       Recovery in REBTS is characterized by: (part 1 of 2)

•       absence or minimum feelings of shame, fear, anticipatory anxiety, etc;

•       no need to avoid sounds, words, and situations;

•       occasional effortless and forward-moving disfluencies;

•       natural-sounding speech with some interspersed easy bounces;

•       Recovery in REBTS is characterized by (part 2 of 2):

•       only occasional thoughts of stuttering;

•       an understanding that people can’t be defined by any single trait of their many traits, especially stuttering;

•       knowledge that communication skills or dignity can not be severely impacted by occasional disfluencies; and

•       courage to pursue any career and seek out romantic and social relationships of choice.

•       Disputing the irrational self talk to arrive at free/flowing speech:

•       The helpful/rational self-talk in REBT:

•       leads to acknowledgement of stuttering,

•       helps to minimize unhealthy emotions, struggle and forcing in speech, and avoidances,

•       thus promotes recovery from stuttering.

•       This self-talk is:

–      based on reality (observed events),

–      logical,

–      pragmatic, useful in solving problems, and

–      non-absolute, flexible and subject to change with new evidence or more astute reasoning.

•       The unhelpful/irrational self-talk in REBTS:

•       leads to upsetting feelings such as  anxiety, shame, guilt about stuttering, etc.,

•       increases avoidance behaviors, and

•       propagates stuttering.

•       This self-talk is:

–      based on fantasy and wishful thinking,

–      not logical,

–      not useful in solving problems, and

–      absolute and unchangeable either by evidence or reasoning.

•       Unhealthy negative emotions are:

•       the result of having irrational/unhelpful self-talk,

•       cause great deal of psychic pain or discomfort,

•       lead to self-defeating behavior,

•       impede us from doing things that could help us to achieve our goals, and

•       lead us to dysfunctional thinking about stuttering.

For example, when we judge a speaking situation to be dangerous, we experience anticipatory anxiety and tend to stutter more frequently and more severely.

•       Unhealthy vs. healthy negative  emotions about stuttering:

•       Unhealthy

•       shame

•       guilt

•       anxiety

•       extreme anger

•       depression

•       hurt

•       envy (spiteful)

•       resignation

•       fear of rejection

•       Healthy

•       disappointment

•       remorse

•       concern

•       irritation

•       sadness

•       sorrow

•       envy (not spiteful)

•       cautious hope

•       concern about rejection

•       Brain functions in recovery from stuttering:

•       The amygdala no longer overreacts to a speaking situation and does not disturbs Broca Area—where fine motor signals for speech are formed.

•       The amygdala has been desensitized.

•       The PFC executive functions are taught to reassert dominance over amygdala and maintain rational/helpful self-talk.

•       The PWS has rewired that part of PFC that was operationally conditioned to struggle, force and avoid.

•       The tasks of REBT are to:

•       detect unhelpful/irrational self-talk,

•       dispute this self-talk, and 

•       arrive at new more effective/helpful self-talk.

This completes the ABCDE chain Activating Event= >Belief= > Consequent emotions/behavior= >Disputing= >Effective outcome (healthy emotions and helpful behavior)

•       Changes in conscious mind are achieved by disputing  and subconscious mind by action exercises

•       Arriving at effective new self-talk requires:

•       pragmatic disputing,

•       empirical disputing, and

•       logical disputing.

•       In pragmatic disputing we ask:

•       Is this unhelpful self-talk helping me to get over my unhealthy negative emotions?

•       Is this unhelpful self-talk making my speech less forced/struggling?

•       Empirical disputing consists of asking:

•       Where is the evidence that proves my unhelpful self-talk is right?

•       Is my unhelpful self-talk consistent with the reality of the situation?

•       Logical disputing consists of asking:

•       Is my unhelpful self-talk logical?

•       Is it logical to think that this situation is awful?

•       Can I really not stand what is going on or what I am fearing?

•       On-line self-help form:

•       An on-line self-help form can be found at either of these two URLs

–      http://www.rebtnetwork.org/library/shf.html

–      http://www.rebtform.com/

•       The on-line self-help form is self-explanatory.

•       As explained in Appendix D, the presenting author is working on stuttering specific Self-Help form https://www.stutteringrecovery.net/rebt-form/

•       Demonstrations:

•       use of online self-help form

•       helps to turn unhelpful self-talk/beliefs into helpful ones

•       is used as REBTS learning too

•       reading and discussing self-talk

•        is also an effective tool for getting the client to understand his unhelpful self-talk

•       source for action homework to rewire the brain

•       Demands:

•       Definition: Self-talk with must, should, ought, need

•       PWS irrational self-talk: “I absolutely must not stutter.”

•       PWS recovery self-talk: “Although I don’t like my stutter, according to the laws of universe I do stutter. I can work toward minimizing the emotions of shame and learn how to use easy bounces and keep my speech moving forward.”

•       Action assignment: Look for the shoulds, musts, etc. and substitute words expressing wants and desires. “I wish I would not stutter. Therefore, I will do self- or professional therapy to minimize it.”

•       Need for acceptance and admiration (a subcategory of demands):

•       Definition: The need to be liked or loved…

•       PWS irrational self-talk: “Everyone should like and love me. If they don’t it is because of my stutter.”

•       PWS recovery self-talk:Although I would like to be accepted and admired by everyone, I understand this is an impossible goal. Some people will reject me for my stutter or for other reasons. This is a fact of life.

•       Action assignment: Ask your parents and friends if they were ever rejected for reasons other than stuttering. Ask how did they deal with the rejection. (“Why fit in when I am born to stand out?” Gunars)

•       Time urgency (a subcategory of demands):

•       Definition: The demand to talk fast before one gets interrupted.

•       PWS irrational self-talk: “I need to hurry because if I don’t I will be interrupted and that would be awful.”

•       PWS recovery self-talk:I don’t like to be interrupted. But if I am interrupted it would not be the end of the world. Putting pressure on me just makes me stutter more.”

•       Action assignment: Insert some extra pauses in your talk. Do some easy bounces and extend the sound until you feel in control. Only then finish the word.

•       Awfulizing:

•       Definition: Taking an unfortunate/uncomfortable situation and obsessively imagining it is worse than it really is.

•       PWS irrational self-talk: “Stuttering is awful. It is so awful that I must avoid it at all costs using avoidances of all types.”

•       PWS recovery self-talk:Stuttering is inconvenient and impacts many aspects of my life, but it is not awful because there are many things I can enjoy despite it.”

•       Action assignment: In every conversation do a voluntary easy bounce on words you do not find normally difficult to say. This is a series of assignments going from easy to difficult speech situations.

•       Low frustration tolerance (LFT):

•       Definition: When someone is very frustrated about anything such as not getting what they want or getting what they don’t want.  They often say, “I can’t stand it.”

•       PWS irrational self-talk: “I can’t stand having the long hard blocks.”

•       PWS recovery self-talk:I don’t like long hard blocks, but I CAN stand them and I am working on making the blocks not as forced and struggling.”

•       Action assignment: When you hit what is a long hard block for you, prove to  yourself you can stand it by continuing in the block. If you do not have any long hard blocks do a long, long easy bounce.

•       Discomfort intolerance (a subcategory of LFT):

•       Definition: Some people will avoid any discomfort or pain at any cost. They feel they should not be asked to tolerate discomfort.

•       PWS irrational self-talk: “I feel too emotionally uncomfortable to tell someone I stutter.”

•       PWS recovery self-talk:Sure there is some discomfort in stuttering therapy assignments. I try to make them easier, but still keep with the spirit of the assignment. No pain, no gain.”

•       Action assignment: Experiment with various ways of telling people that you stutter.

•       Self-downing:

•       Definition: Many people down their whole self because they have one characteristic they don’t like.

•       PWS irrational self-talk: “Stuttering makes me worthless. I am not as worthy of a person as someone who does not stutter.”

•       Self-downing, continued:

•       PWS recovery self-talk: “Human worth can not be measured, because we each have so many good and bad characteristics. In order to evaluate it we would have take into account our characteristics, our past achievements, and what we might do in the future. Then we would have to assign weighting, how valuable each of the individual characteristics, achievements, and potentialities are. The task is just not possible.”

•       Action assignment: Above all do not use stuttering severity and frequency as a definition of yourself and  your worth. Think and write an essay to discuss what makes a person a better or more worthy than any other. Then discuss the idea that you are valuable to yourself because you exist and can enjoy yourself.

•       Condemnation and damning
(a subcategory of self-downing):

•       Definition: Many PWS feel that if a person has done something wrong or has not accomplished something he should be condemned or damned to hell or worse.

•       PWS irrational self-talk: “Joe did not let me finish what I wanted to say. He is an intolerable bloke. I am angry. Damn him. I really want to strangle him.”

•       PWS recovery self-talk: “Joe made a mistake. He probably does not know how badly I feel, how inadequate I feel when he interrupts me. If an opportunity presents itself, I will explain to him why he should not finish a PWS sentence.

•       Condemnation and damning
(a subcategory of self-downing), continued:

•       Action assignment: Gather three instances when a person interrupts you. Use REBTS to talk yourself out of your anger. Then try to explain to the friend why he should not do that without damning and condemning.

•       All or nothing, black and white, or overgeneralized thinking:

•       Definition: Thinking in extremes: Using words like always, never, perfect, etc.

•       PWS irrational self-talk: “I have to talk perfectly without any stuttering or disfluencies.”

•       PWS recovery self-talk:Nobody ever talks without any disfluencies and/or stutters. Good enough is good enough.”

•       Action assignment: Select a News Channel or a Talk show on TV and write down the hesitations, disfluencies and stutters that the speakers have. Collect the information for at least six speakers.

•       Helplessness and hopelessness (a subcategory of all or nothing thinking):

•       Definition: Some people have given up on self- and professional-therapy.

•       PWS irrational self-talk: “I cannot cure my stuttering. I can’t lessen my struggling/forced stutters.”

•       PWS recovery self-talk:I can improve my speech to be less forced and struggled. And I can alter my feelings of shame and anxiety about my speech. What I might have done in the past might not work, but there are new therapies as REBTS that give me hope.”

•       Helplessness and hopelessness (a subcategory of all or nothing thinking), continued:

•       Action assignment: Go to  https://www.youtube.com/watch?v=Rb0A5Z-8cik play the video and remind yourself that it is possible to recover wholly or partially from stuttering.. .

•       Lack of gratitude (a subcategory of all or nothing thinking):

•       Definition: Our lives have good and bad aspects. Some people focus only on the bad, as stuttering, and are not grateful for the good aspects.

•       PWS irrational self-talk: “Stuttering ruins my whole life. There is nothing I can be grateful for.”

•       PWS recovery self-talk: “Hey! I am alive. I can hear, do, see, smell, taste the marvels of world around me. I can think about, feel and enjoy the world around me. How exiting. Let me at it, I want to live fully. Stuttering can’t stop me.”

•       Lack of gratitude (a subcategory of all or nothing thinking), continued:

•       Action assignment: In your journal every day when you wake up list three things you can be grateful for. Every night when you go to bed write three things that you enjoyed or did well.

•       General session flow:

•       Session sequence

–      Listen and answer PWS questions

–      Review homework assignments (recorded in email)

–      Discuss philosophy of From Stuttering to Fluency and SOS Help for Emotions

–      Dispute client’s irrationalities & use on-line self-help form

–      Continue demonstration of easy bounces and require client to practice them

–      Together with PWS generate homework assignment e-mail

–      Request feedback

–      Homework assignments:

•       Reading the books by Neiders, Ross & by Clark

•       Immersion during waking hours in easy bounces (when no one is around talk to yourself, if someone is around make conversation, if in foot traffic fake it as if you are talking on the phone)

•       Filling out the on-line self-help form

•       Disputing any irrationalities

•       Writing a sentence or paragraph on helpful self-talk on an index card and then reading it 5 times a day till next session

•       Doing the action exercises

•       Writing in a journal

•       Joining Toastmasters (optional)

–      References

•       SOS Help For Emotions 3rd Ed. Lynn Clark

•       From Stuttering to Fluency: Manage Your Emotions and Live More Fully G. Neiders and W. Ross

•       Website www.stutteringrecovery.net